Analysis Of Clinical Features Of Guillain-Barre Syndrome With Autoimmune-Related Antibodies

BackgroundGuillain-Barre Syndrome（GBS）is a type of immune-mediated acute inflammatory demyelinating polyradiculoneuropathy as the most common cause of acute flaccid paralysis that affects about 100,000 people worldwide each year.Preinfection is the main cause of GBS.The current treatment is mainly intravenous immunoglobulin and plasma exchange,and most patients have a good prognosis.In addition to infection,there are other non-infectious causes of GBS,including surgery,intravenous ganglioside drugs,vaccination,pregnancy,and less common causes include autoimmune diseases,tumors,etc.We encountered some special cases of GBS in clinical work,with non-obvious infection incentives,consistent with the clinical presentation of GBS and some positive autoimmune antibodies,the IVIg treatment effect was not good,and some of them had recurrence.ObjectiveBy comparing the clinical information of GBS patients with abnormal autoimmune antibodies and normal autoimmune antibodies in our hospital,exploring the differences of clinical characteristics between the two groups of patients.To review the case reports of autoimmune diseases（SLE and SS）with GBS as clinical manifestations and GBS related to paraneoplastic,comparing with the cases of GBS with abnormal autoimmune antibodies in our hospital,and analyzing their clinical characteristics,in order to identify these GBS associated with autoimmune diseases and tumors as early as possible in clinical work,adjust treatment in time,and improve patient prognosis.Methods1.Collecting 24 GBS cases with abnormal autoimmune antibodies and 10 GBS cases with normal autoimmune antibodies who were hospitalized in the second Hospital of Jilin University from January 2017 to October 2021,to compared the differences in clinical manifestations,cerebrospinal fluid laboratory examination results,electrophysiological examination results and treatment.2.Retrieving the GBS cases with SLE in the PubMed database as the control group,analyze their clinical data,comparing with the GBS cases with SLE-related autoimmune antibodies in our hospital,and exploring the clinical differences between the two groups of cases.3.Retrieving the GBS cases with SS in the PubMed database as the control group,analyze their clinical data,comparing with the GBS cases with SS-related autoimmune antibodies in our hospital,and exploring the clinical differences between the two groups of cases.4.Retrieving GBS cases with tumor in PubMed database,and summarizing and analyzing their clinical characteristics.Result1.Comparison and analysis of clinical characteristics between GBS patients with abnormal autoimmune-related antibodies and GBS patients with normal autoimmune-related antibodies in our hospital: There were no significant differences in gender,age of onset,length of hospital stay,prodromal factors,main initial symptoms,clinical manifestations,auxiliary examination results,treatment and prognosis between the two groups.2.Comparison and analysis of clinical characteristics between GBS patients with SLE in PubMed（control group）and GBS patients with abnormal SLE-related autoimmune antibodies in our hospital（observation group）: There were statistically significant differences in age of onset,gender,prodromal factors,and average cerebrospinal fluid protein content between the two groups（age: P=0.003;gender: P=0.011;prodromal factors: P=0.007）.Compared with the control group,the average age of onset in the observation group was older,male patients were more common,and most of them were accompanied by prodromal factors,and the average cerebrospinal fluid protein content was lower.There were no significant differences in clinical manifestations,laboratory and electrophysiological results between the two groups.The proportion of GBS variants in the control group was higher than that in the observation group,and the difference was statistically significant（P=0.008）.The observation group was mainly treated with IVIg.In the control group,in addition to IVIg,more than 90% of the patients were treated with CS,and more than half of the patients were treated with PE and immunosuppressive agents.The improvement rate was higher in both groups.3.Comparison and analysis of clinical characteristics between GBS patients with SS in PubMed（control group）and GBS patients with abnormal SS-related autoantibodies in our hospital（observation group）: There were no significant differences in gender,age of onset,prodromal factors,clinical manifestations,and auxiliary examination results between the two groups.There were no significant differences in gender,age of onset,prodromal factors,clinical manifestations,and auxiliary examination results between the two groups.On treatment,more than half of the patients in the control group used CS,and the prognosis of the patients in both groups was good.Since the sample size is too small,The clinical significance of the above results is questionable,and it is necessary to further expand the sample size comparison.4.Clinical characteristics of GBS patients with tumors in PubMed: more men than women,lymphoma is the most common primary tumor,less prodromal infection,cranial nerve damage is most common in the facial nerve,relatively more dyspnea,combined treatment of primary tumors may improve neurological performance,and there is a higher mortality.Conclusion1.There is no significant difference in clinical characteristics between GBS with and without abnormal autoimmune antibodies,suggesting that it is impossible to determine whether patients have autoimmune system abnormalities only from clinical manifestations,and screening for autoimmune antibodies and related laboratory tests must be performed.2.There is no statistical difference in neurological manifestations between GBS with SLE and GBS with SLE-related antibodies,but only slightly different in age,gender and prodromal infection.Combination therapy with corticosteroids and cyclophosphamide is used as first-line therapy in the coexistence of GBS and SLE.3.There is no significant difference in gender,age of onset,clinical manifestations,and auxiliary examination results between GBS with SS and GBS with SS-related autoimmune antibodies,suggesting that GBS with SS-related autoimmune antibodies should be followed up and observed,whether there are symptoms of dryness.If necessary,carry out related laboratory tests to clarify.4.More men than women in GBS with tumor,there are fewer prodromal infections,cranial nerve damage is more common in the facial nerve,and dyspnea is relatively common.The treatment and prognosis are related to the combined tumor.